UK slips down European health table

The 2007 Euro Health Consumer Index ranks the UK at 17th position in Europe. Tom Ireland reports.

The UK is falling behind countries such as Estonia and the Czech Republic's rising healthcare standards, according to the 2007 Euro Health Consumer Index (EHCI).

Now ranked 17th out of 29 European countries, the UK appears to be slipping down Europe's healthcare league table despite increased funding. It performed worse than in 2006, when it was 15th out of 26.

The index aims to rank the consumer friendliness of healthcare systems across Europe.

The study's conclusion was that countries with a social insurance system (referred to as 'Bismarck') outperformed the centrally funded, 'Beveridge' systems.

A Beveridge model, like the NHS, with centrally driven funding, worked well in smaller Scandinavian countries. But in a more populous county like the UK, the level of organisation becomes too complex, and efficiency drops, according to the report's authors.

The top-ranking five countries (Austria, the Netherlands, France, Switzerland and Germany) have systems where patients choose between insurance providers. This top five all score within 36 points of each other in the rankings, and there is a 30-point gap before the first Beveridge health system.

EHCI director Dr Arne Bjornberg concluded: 'Bismarck runs rings around the Beveridge system. When financing and provision are separate they outperform systems where they are in the same organisation. It is well proven in other industries and health is no different.'

The UK scored a total of 518 points from a maximum of 1,000. The report's leader in providing public healthcare was Austria, with 806. The five key performance areas measured were patient rights and information, waiting times, health outcomes, 'generosity' (amount of provision) and pharmaceuticals.

The UK led the field in providing patient information, with NHS Direct, the Parliamentary and Health Service Ombudsman and quality rankings for providers all receiving praise. In the waiting times section, improved primary care performance appears to have been dragged down by non-acute operation or MRI scan waiting times.

In the 'outcomes' section of the results, the UK's good heart infarction mortality score stood out from the rest of Europe, with many nations described as 'appallingly poor'. This performance was let down by lower-than-average cancer five-year survival rates and high rates of MRSA infection.

Primary care was heavily involved in the areas showing progress, and Dr Bjornberg agreed that, generally, primary care in the UK was very good. 'Unfortunately, there were no indicators specifically aimed at primary care, but in the UK it does seem to be good quality.'

Deployment of new cancer drugs was an area where the UK struggled, although access to new drugs overall scored highly.

Dr Bjornberg said: 'There seems to be an obstructive attitude towards new cancer drugs. The UK is slow at making drugs available to patients.

'Patients in the UK have the right to expect more. Despite large funding increases, the UK remains a mediocre performer.'

Dr Bjornberg said that although GP access had improved, hospital waiting times had been poor. He believed that direct access to treatment centres on the continent had shortened waiting lists and did not affect healthcare spend.

'In the countries that have opened the floodgates, we don't see, as you might expect, a stampede of people. Instead, we don't have significant waiting times. The GP gatekeeper system does not keep costs down.

'This may represent the end of the road for the rationing approach the UK has pursued.'

When the scores are adjusted to allow for the average spend per capita, the UK drops even lower. It is fourth from bottom in the 'bang for buck' league, a ranking of health systems accounting for how much is spent nationally.

But Surrey GP Dr Peter Smith, president of the National Association of Primary Care (NAPC), said previous governments found it cheaper with a Beveridge system.

'It is about finding a balance between what the public can afford and what is politically affordable,' he said.

Dr Smith said the report contained some important flaws: 'Diabetic outcomes were not available in other countries and it is a crucial outcome. If the UK's primary care outcomes were included, rather than just secondary care, then it is an area the UK would have scored highly.' He added that the immunisation data looked unconvincing. He also disputed whether direct access to a specialist should have been included in the index.

'The GP as a gatekeeper is such an important element designed so there is a rational use of secondary services,' he said.

The report has been criticised by the DoH, which believes its figures are out-dated and do not reflect patient satisfaction.

The DoH defended its investment in the NHS, questioning the methodology used in the report.

A DoH spokesman said: 'Some of the data which inform this study are between two and four years old, meaning that significant improvements seen recently in the NHS, such as reducing the average wait for treatment to just six weeks, are not fully taken into account.'

The report itself acknowledges that 'the results definitely contain information quality problems' and should be treated 'with great care'.

Dr Smith said: 'Overall there are some very important questions raised. I don't think you can look at the ranking with any real objectivity, but we can't be complacent, and I hope the issues raised will be looked at.'

EHCI 2007 results

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